Other Psychotic Disorders  Dissociative Disorders

Other Psychotic Disorders Dissociative Disorders PowerPoint PPT Presentation

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Other Psychotic Disorders. Schizophreniform DisorderBrief Psychotic DisorderSchizoaffective DisorderDelusional DisorderShared Psychotic Disorder. What is a Psychotic Disorder. Psychosis A break from reality Often involves difficulties interacting with and perceiving the real worldSplit between thoughts and emotions.

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Other Psychotic Disorders Dissociative Disorders

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1. Other Psychotic Disorders & Dissociative Disorders 7.14.2006

2. Other Psychotic Disorders Schizophreniform Disorder Brief Psychotic Disorder Schizoaffective Disorder Delusional Disorder Shared Psychotic Disorder

3. What is a Psychotic Disorder Psychosis A break from reality Often involves difficulties interacting with and perceiving the real world Split between thoughts and emotions

4. Schizophreniform Disorder Criteria A, D, and E of Schizophrenia are met (To help you remember: Criteria A: 2+ characteristic symptoms (delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative affect) present for significant part of month Criteria D: Schizoaffective Disorder and Mood Disorder with Psychotic Features have been ruled out Criteria E: Not due to a GMC or substance) An episode of the disorder (including the prodromal, active, and residual phases) lasts at least 1 month but less than 6 months

5. Schizophreniform Disorder Essentially, exactly like Schizophrenia, but the duration is shorter Schizophrenia: 6 months or longer Schizophreniform: 1-6 months Often used as a provisional diagnosis during the first months of a psychotic illness Thus, this diagnosis not infrequently changes to Schizophrenia after 6 months have passed without complete recovery

6. Facts about Schizophreniform Disorder Prevalence: Varies substantially: Approx. 0.2% in industrialized areas Approx. 1% in non-industrialized areas May be explained by higher functioning and better prognosis for psychotic disorders in non-industrialized areas Gender: Approx. equal rates Age of Onset: Same as Schizophrenia (keep in mind gender differences) Course: 1/3 recover within the 6 month period 2/3 progress into Schizophrenia

7. Brief Psychotic Disorder A. Presence of one or more of the following symptoms: Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid levels of functioning C. Disturbance is not better accounted for by another mental disorder and is not due to a GMC or substance

8. Brief Psychotic Disorder vs. Schizophrenia/Schizophreniform Criteria Schizophrenia/Schizophreniform Disorder 2 symptoms needed (there is an exception to this rule) Can include Negative Affect Brief Psychotic Disorder Only 1 symptom needed Cannot be Negative affect Duration Schizophrenia: 6+ months Schizophreniform Disorder: 1 – 6 months Brief Psychotic Disorder: 1 day – 1 month

9. Facts about Brief Psychotic Disorder Prevalence: Unknown (symptoms often do not persist long enough to come to the attention of mental health professionals or researchers) Gender: Unknown, can assume to be equal Age of Onset: Late adolescence to early adulthood Course: By definition, no longer than 1-month

10. Schizoaffective Disorder An uninterrupted period of illness during which, at some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the illness Not due to a GMC or substance

11. Subtypes of Schizoaffective Disorder Bipolar Type: if the disturbance includes a Manic or a Mixed episode Depressive Type: if the disturbance only includes Major Depressive Episodes

12. Facts about Schizoaffective Disorder Prevalence: Unknown, but seems to be less common than Schizophrenia Gender: Equal rates of Bipolar Subtype Women tend to have higher rates of the Depressive subtype Age of Onset: Late adolescence to late in life Average age = early adulthood Bipolar Subtype – more common in younger adults Depressive Subtype – more common in older adults Course: Better prognosis than Schizophrenia, worse prognosis than mood disorders Better prognosis for Bipolar subtype

13. Delusional Disorder Nonbizarre delusions lasting for at least 1 month Criterion A for Schizophrenia have never been met (However, tactile and olfactory may be present if they are related to the delusional theme) Behavioral functioning is not markedly imparied and behavior is not obviously odd or bizarre If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods Not due to the direct effects of a GMC or substance

14. Types of Delusional Disorder Erotomanic – delusions that another person, usually of higher status, is in love with the individual Grandiose – delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person Jealous – delusions that the individual’s partner is unfaithful Persecutory – delusions that the person (or someone who is close to the person) is being malevolently treated in some way (most common) Somatic – delusions that the person has some physical defect or general medical connection Mixed – delusions characteristic of more than one of the above types but no one theme predominates Unspecified – no information provided

15. Facts about Delusional Disorder Prevalence: 0.03% (community samples) 1-2% of inpatient mental health admissions Gender: Equal rates, however, rates of specific types of delusional disorder may vary (e.g. Jealous type) Age of Onset: Can be quite variable – ranging from adolescence to late in life Course: Can also be quite variable Can be chronic or may remit completely Symptoms may wax and wane or disappear completely and then reappear

16. Shared Psychotic Disorder (Folie á Deux) A delusion develops in an individual in the context of a close relationship with another person(s), who has an already-established delusion The delusion is similar in content to that of the person who already has the established delusion The disturbance is not better accounted for by another psychotic disorder or is due to a GMC or substance

17. Shared Psychotic Disorder The delusions are shared between two people are in a close relationship (husband and wife, parent and child, siblings, etc.) Typically, the person with the original delusion is the more dominant personality in the relationship Generally the delusions are only shared by two people, but can be shared among large groups of people as well

18. Facts about Shared Psychotic Disorder Prevalence: Unknown, goes unrecognized Gender: Somewhat more common in women Age of Onset: Seems to vary Course: Tends to be chronic, because the disorder tends to afflict people in extremely close, long-lasting relationships However, if separated from the person with the original delusions, the delusions usually dissipate

19. Dissociative Disorders Dissociative Identity Disorder Dissociative Amnesia Dissociative Fugue Depersonalization Disorder

20. Dissociative Identity Disorder The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self) At least two of these identities or personality states recurrently take control of the person’s behavior Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness Not due to a GMC or substance

21. Dissociative Identity Disorder Identities At least two of these recurrently take control of a person’s behavior Can be categorized into three types: Core identity: superego, tied into rules of society, highly conscientious, often timid 1st alternate identity: id, low self-control, gives into impulses, pleasure seeking, aggressive 2nd alternate identity: ego, more rational, usually the most psychologically healthy

22. Facts about Dissociative Identity Disorder Prevalence: Up for debate (see next slide) Gender: 3-9 times more common in females Women seem to have more identities than men: Women: average of 15 identities Men: average of 8 identities Age of Onset: Most likely childhood - adolescence Course: Chronic, episodic Tends to recur with new trauma and substance abuse

23. Dissociative Identity Disorder Prevalence Up for debate Rates have increased dramatically over few decades First case reported in the 1850’s Several cases in 1880’s-1900’s By the 1970’s, only about 200 cases in all Now, some psychologists claim that up to 1% of the general population has this disorder Individual clinicians are not reporting having dozens to hundreds of such clients Rates very uneven across countries Rates very uneven across clinicians within countries The rates of this disorder is very controversial…some psychologists doubt its existence at all

24. Dissociative Identity Disorder Risk Factors Severe child abuse, especially sexual abuse (reported in 95% of cases However, unclear from reports whether this abuse is always remembered or “recovered” in therapy through hypnosis Anecdotal evidence suggests that it’s more often “recovered” Anecdotal evidence suggests having generous psychiatric medical coverage is a risk factor (could be due to either prolonged contact with the patient enabling the recognition of the diagnosis, or misdiagnosis for gain)

25. Dissociative Identity Disorder Question of Validity Studies show differences in psychological test results and physiological states between “alters” Alternative theories: Could be due to distinct personalities Could be due to role enactments Extremely heated controversy over iatrogenesis vs. natural occurrence (iatrogenesis = “caused by treatment”)

26. Dissociative Amnesia One or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness Not better explained by a another mental disorder and is not due to a GMC or substance Symptoms cause clinically significant distress or impairment in functioning

27. Facts about Dissociative Amnesia Prevalence: Increasing rates in recent years… this is open to interpretation Gender: Unknown, most likely equal Age of Onset: Any age, childhood to adulthood Course: Duration of the amnesia can be minutes to years Most likely episodic, can be chronic Having one episode may predispose a person to having additional episodes

28. Dissociative Fugue Sudden, unexpected travel away from home or one’s customary place of work, with inability to recall one’s past Confusion about personal identity or assumption of a new identity (partial or complete) Not better explained by a another mental disorder and is not due to a GMC or substance Symptoms cause clinically significant distress or impairment in functioning

29. Facts about Dissociative Fugue Prevalence: 0.2% (community) May be higher in times of war/widespread trauma Gender: Unknown, most likely equal Age of Onset: Typically seen in adults Onset related to traumatic events Course: Generally temporary, rapid recovery Can be more chronic

30. Depersonalization Disorder Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body During the depersonalization experience, reality testing remains intact Not better explained by a another mental disorder and is not due to a GMC or substance Symptoms cause clinically significant distress or impairment in functioning

31. Facts about Depersonalization Disorder Prevalence: Unknown in the community Up to 1/3 of individuals in life- threatening danger Up to 40% of hospitalized for mental disorders Gender: Twice as common in females Age of Onset: Mean age = 16 years Often the result of a traumatic experience Course: Usually chronic Usually waxes and wanes

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